# Place the actions in order for safely starting one unit of packed red blood cells.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395531&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

Place the actions in order for safely starting one unit of packed red blood cells.

When fully prepared to begin, retrieve the correct unit and inspect its label, integrity, color, expiration, and time out of controlled storage

Connect the blood-administration tubing with 0.9% sodium chloride and start the unit slowly at the prescribed initial rate

At the bedside, complete the required two-person or validated electronic check of client identity, unit number, blood type, compatibility, and expiration

Verify the prescription and informed consent, explain reaction symptoms, confirm adequate venous access, and obtain baseline assessment and vital signs

Remain with the client for at least the first 15 minutes, reassess for reaction and vital-sign changes, and adjust the rate only if stable and prescribed

## Explanation

Complete consent, teaching, access, and baseline assessment before retrieving the unit so transfusion can begin promptly after issue. Inspect the unit, then perform the required bedside identity and compatibility verification. Start through approved blood tubing with compatible 0.9% sodium chloride at the prescribed slow initial rate. Remain with the client during the first 15 minutes because acute reactions often appear early; reassess before increasing the rate.

## In-depth explanation

Correct sequence
Prepare the client → retrieve and inspect → verify at bedside → start slowly → remain and reassess for 15 minutes.

Why this is correct
Identity and compatibility errors can be catastrophic. Baseline findings allow early comparison, and close observation during the initial period supports rapid recognition and cessation if a reaction develops.

NCLEX decision rule
Do not fetch blood until the client, access, consent, equipment, and nurse are ready to start.References
1NCBI Nursing Advanced Skills: Administer Blood Products
2NCBI: Blood Transfusion

## Clinical scenario

Pretransfusion through first 15 minutes
The adult client is hemodynamically stable and has no history requiring special product handling. Follow the prescription, blood-bank requirements, manufacturer instructions, and facility policy.

## Key concepts

- **Compatibility Testing** — Blood-bank testing and verification used to reduce immune incompatibility between a recipient and a donor unit.
- **Hemovigilance** — Surveillance for adverse events across blood collection, issue, administration, and follow-up.
- **Acute Transfusion Reaction** — A new adverse response that begins during or shortly after blood-component administration.

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